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APPLICATION FOR LIOUIO WASTE PERMIT <br /> ,,,,AN JOAQUIN COUNTY PUBLIC HEALTH SERVICv�, O <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)458.3420 I <br /> NOIFREFUNDABLE PERMIT EXPIRES i YEAR FROM DATE ISSUES ( 1/1 /'![✓ <br /> (CEmPIAM In Tlpf u) VVVvvv �l.!6 <br /> AffHCATION IS NEtBY MAOE TO THE.JOAOVIN..MY ED.A PERMIT TO CONHTNVCT ANDNR MCIALL INE V Rn DEBCMBw. THIS AERICATWH IB MADE IN MMAHANCf WRN SAN <br /> NAa N COuS IY OEVELOEMENF TITAL CHAFTEE B-X111110.-3 AND THE STANDARDS OFF GAN JOAOVIN COUNTY wBVC HEALTH BffR[VLCEB.FNVIIWHMENTA-HEALTH DMED N. /I,.S <br /> JOp ADDI�..I AAPHI ✓s-5/ IJVG['�6w K�J CT' SI'" �LO�T�BQF c' <br /> T� C EW.HAS ,r[ lD l{�1 L Aw1LAS RbE—sem y <br /> /V 1.o-, ADMQB.i21 E' LITE r �UCI �Zzs RIDNE cl Sal-&96 <br /> 6VSCONTMCTOFSEN R AODK VCf RbNf <br /> TYR Of AEFTIC WOR: NEW INSTAWTION❑ RRMW.Dflu.H 19 ❑ <br /> MO DEPIW LYSTEM PERMITTED EFINNI aWEH I6 AVAMBIE W RM Tbrxl l 1 NOW f�TQ' <br /> J/ Apfls .I rfj I <br /> INS...WILL.. REBIOENCE EO [OMMfpC1At❑ OTHER❑ <br /> XVASfEI Of..VISTS:� <br /> ISIS Efl OF wLTDAOEPIN OIIFFET:H(/IC1¢¢ MSRTIB �IOF ANAM.I : (j 1yry{1�111 <br /> 10SI ,tyF <br /> //FIIM TANRM4SE 1MF ❑TY4[/MFQ lY��v'Lt1 CAYAcfIY NO.coMFATRMmTs UUN OUR)1Y <br /> VVItT`II/PFA 4 A <br /> TMfNrfuxrO aBTAnc[rO xEwpuT: wEuS� -A' PoVNOATOM�� FpORmY uxEy` �UBL)UBLIC HEALTH SERNCES <br /> 11fTATATWX0 MEE T -SNDMP SANOON6EEP..RIENCL064OeYBIEMI ENNHDNIfIENTAL HEALTH DI�SION <br /> ASS VICMXO OM[ •LENGTH Of IMEB —Ue �e-JLD_. aRANCETOHEAPE R:WELLy r��TOMIDAT1Of1�PMRRIY LNE 5 <br /> FELT.Lm SODTH IFNOTH DEF�aeTANCE TO NEAILR:M-I MuNDATDN—RYJPEp1Y LME <br /> MOMDw <br /> Cl. IENOTII DEFT" dBTANCE TO NEARST:W"F�LL' ��//yy�S ...ATpH ROPENTY Vw <br /> A@AO[RTA 62E�NUM.N �T aeEAN1:E TO NEAREST:WEVL�PoVNOAION�"En"NY f` <br /> MMRE ❑wOTH Ipp(H DEPTH MSTAHCE TO NEAREST: POVHOATON--ANDPEHTY LME <br /> d6PoBAL AD... ❑WDTH LEEOTN DEPTH_MATAN,"o MANDOE:W'EH_MUNOATOx._RORpIY IME <br /> 1 HERIBV COAT"THAT I NAVE PREPA1ED THIS APRICATDN AND THAT THE MRS WILL M DONE IN ACCORDANCE WITH SAN JOAa11N COUNTY OPDINANCE6 AND STATE TAW..AND"OE. <br /> NOIIEOIRATONB OF THE..AAaHN COVNTY.HOME OMER OR MAIMED AOFM'SMONATNIE CFALIFNSTHE wLLOWMNI:'I ClbO THAT MTINK RM—E OF THEYAJRL PERN18CM <br /> TMS PfRAN I.MNED.1 MiALL XOT fMROY AMY REASONMBVCHA MANNEfl AS TO.FCOMF NIJfCT TO WO1xMAN'.COMIEN SILTONTAWS Of C.VlIO1MA' <br /> D"."On <br /> w nn...ACTINO mONATVIE CE.;;T�7 <br /> THE FOLLOWING:l CERNFY THAT M TM FEI60N.1ANCE OF TM YNR[FOp WMCNTMB FFWAR I.I..Um.I YWl FFAROY RflwNB w61ECi TO <br /> WOTKMAH'E CDMFEHB�Op UWTHEAM MV{T CALL 1.[MOI#ETM AOVAXC[FM A�LL_flEOMaRw/IN6RLTOME. COMRETE a1AWINO MTDw. <br /> OHMS.x TIRE: f4✓ _ DATE: <br /> ROT.OMw To NEAHn RE.-- a ,y 1 <br /> �- AME.OF...OF.A .NEAREST TO..FOUTOMB THE N FDPENY. •IS.TO ..OF"OVBE SfWAOEdWBAL.Y6TW 0p FIOPoBm U <br /> OVIUNE OF THE HWRNTY.WITH dMEN BIONI AND HO TH a11ERON. L AfdnlpN OF SEWAGE dRTIBAL.Y.R H. <br /> OIMENWONw O VRINF.AND LOCATION OF ALL E%I.LINO AMD FPOm6ED 6T11VCTVIEB. 6.LOCATION OF WELLS WITHIN..OF ONE MYXCPFO FI FT.ON <br /> ' IWLVDINO COVTNO ANFA.SUCH AS PATI04 D AYS,AND WA11(B. THE TORMV OR AOAMMO ROIEATY. <br /> jeISSES <br /> I�" <br /> P y8 Q%ls NOUS E <br /> ..... ..........._._. <br /> AIPIICATrox ACCERm M .\ITIJyI)'AV1vA/�}yf/v^F I Iv`O, yv.�i,•1�1 J1F DAie AREA: �*J <br /> I.,RE OA BUMP PHONE."LV DATE I I iMAL M6PECTOH.V DATE C� - <br /> _ !��dMtWHAL COMMEMF: Y <br /> ''nAII y ✓ j::: f <br /> L <br /> AccDLMTme ONLr: An" FACT <br /> FRIM. AMONIr MMIITED CIIBIV 2A6X —S— DATE NIRMTMVA.61 IMVOIC[J <br /> � .f us 335 aD 5 <br /> Pub.HAS"Sem, Env✓O.174(3/96) <br />